VITALS - Death Certificate of: Lola Davies; Fillmore, Millard co., Utah

Transcribed by Stephen D. Robison (kinseeker @ hotmail.com)
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FHL Film # 2229072, State of Utah, Death Certificates, Millard County:
              
Certificate Number:  0500716
              Death place:  Fillmore, Millard
              Name:  Lola Davies
              Usual residence:  Fillmore
              How long resident:  
              
PERSONAL AND STATISTICAL PARTICULARS
              Sex:  Female
              Color:  White
              Birth date:  March 27 1905
              Age:  Still born
              Marital status:  
              Birth place:  Fillmore, Utah
              Father:  John Henry Davies
              Father's birth place:  Fillmore, Utah
              Mother:  Ellen L. Robinson
              Mother's birth place:  Dover, San pete Co, Utah
              Occupation:  
              Informant:  J. H. Davies
              Informant's address:  Fillmore, Utah
              Burial place:  Fillmore, Utah
              Burial date:  March 28th
              Undertaker:  Jesse Millgate
              Undertaker's address:  Fillmore, Utah
              Filed:  
              Registrar: 
              
MEDICAL CERTIFICATE OF DEATH
              Death date:  March 27 1905
              Cause:  Breach presentation with retention of head
              Where contracted:  
              Duration:  
              Contributory:  
              Where contracted:  
              Duration:  
              Doctor:  J. C. Robison
              Dated:  March 28 1905
              
Permission is hereby granted to bury the body of the person above described
              Health Officer:  J. C. Robison
              Address:  Fillmore, Utah
              Date:  March 28 1905